NPI | 1871664839 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine (Licence: CA G29239) |
Additional Taxonomies | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: CA G29239) |
Enumeration Date | 2006-11-13 |
Last Update Date | 2020-04-15 |